Inappropriate elimination in cats: doctor, staff, and patient survival (Proceedings)


Inappropriate elimination in cats: doctor, staff, and patient survival (Proceedings)

The most common behavior problem of cats is inappropriate elimination (IE). It is the cause of owners taking drastic measures including banning the cat to the outdoors, abandonment, surrender to a shelter, and euthanasia. It is important that a simple cookbook answer not be used for these cats as is illustrated by the approach that I use.

Most IE is driven by a behavior disorder. However, there is almost always something that initiates the problem. Sometimes IE begins with a stress-producing or insecurity-producing event. Sometimes it begins due to a medical condition. We need to try to find the initiating event and deal with it. If we can do so, treatment for the initiating event is done simultaneously with treatment for the behavioral aspect. However, sometimes the initiating event is resolved, and we only left with the behavioral aspect. But, failing to look for the initiating event can be a disastrous oversight when dealing with this problem.

Underlying medical causes

Although many cats present with behavior-driven IE, this behavior may originate in several physical abnormalities. It is important to address these before proceeding to behavior modification techniques. History is sufficient for some; specific tests are needed for others.


Bladder inflammation, whether sterile or bacterial, frequently results in inappropriate urination. These cats typically have one or more clinical signs of dysuria, pollakiuria, increased frequency of urination, and hematuria. However, these may be present and missed by owners. Urinalysis usually reveals bacturia, hematuria, and crystalluria although some affected cats will have a normal urinalysis. A urine culture is the most sensitive way of detecting bacturia. Bladder ultrasound can detect chronic cystitis (thickened, irregular bladder walls) as well as uroliths.


Certain types of pain may be manifested when the cat goes to the litter box and positions to urinate or defecate. Most notable is pain from the lumbar spine, lumbosacral junction, hips, and knees. Uroliths in the bladder can also create pain that is manifested when the cat urinates. The discomfort associated with constipation can also be litter box related. These cats' histories may include lameness, reluctance to jump or run, failure to raise the tail when petted, increased sedentary lifestyle, hiding, personality change (especially aggression), reluctance to being picked up, sitting or lying down slowly, a hunched up posture of the back, standing (instead of squatting) in the litter box when urinating or defecating) and protecting a body part. Radiographs of these areas are diagnostic. Litter box-related pain can also be generated by ingrown toenails, especially in older cats, and clumping litter that sticks to the hair on the ventral surface of the feet. These can be detected by examination of the feet. Impacted or infected anal sacs will become painful when the cat defecates, sometimes resulting in a litter-box-pain association. Anal sac palpation or expression is diagnostic.


Polyuria may cause a cat to urinate inappropriately. Common causes of polyuria in cats include diabetes mellitus, renal disease, and hyperthyroidism. Blood panels that include glucose, creatinine, BUN, and total T4 are diagnostic.

Very Ill Cat

Very ill cats often do not have the energy to walk across the room or the house to get to the litter box. They will often urinate (or defecate) where they lie.

The work up

The ideal workup consists of directed history taking, physical examination, a blood chemistry panel including total T4, radiographs of the abdomen, lumbar spine, hips, and knees, bladder ultrasound, urinalysis, urine culture, and anal sac palpation/palpation. When possible, the minimal workup should consist of directed history taking, physical examination, anal sac palpation/expression, radiographs, and urinalysis. Your clinical judgment and the owner's motivation and finances will direct how extensive your workup can be.

Litter box issues

Cats will avoid litter boxes under several situations that include:

  • Too few litter boxes for the number of cats in the household. The "official" recommendation is one more litter box than the number of cats. This is not practical for many cat owners, but it is a rule that should be imposed, or at least discussed.
  • Hooded litter boxes. Although there are many advantages to hooded litter boxes (for owners, at least) odors are trapped within the litter box making it undesirable to many cats. Hoods should be removed, at least until the problem is resolved.
  • Type of litter. Clumping litter best simulates sand or soil and is preferred by most cats. It is my litter-type of choice unless it is heavily scented or deodorized. When IE is occurring, avoid clumping litters for "multiple cats" due to the odors that may offend cats. If the owner objects to dusty clumping litter, recommend that a higher quality product be purchased. Synthetic litters made from wheat, newspaper, etc. can result in substrate aversion. Although well accepted by many cats, I recommend avoiding them in IE situations.
  • Recent change of litter type or brand. Cats are creatures of habit. A change in the litter type or a different brand of the same type can result in IE.
  • Dirty litter box. The litter box should be scooped each day (several times if used by multiple cats) and dumped and scrubbed once per month.
  • Location. Cats often avoid litter boxes that are in high traffic areas and prefer those in somewhat secluded locations.
  • Litter box liner. Some cats do not like these liners. When IE is occurring, remove them.
  • Side height. Cats with arthritis can have difficulty climbing in or out of litter boxes with sides that are 4 inches or more high.